EUROPEAN REGIONAL
STATUS REPORT ON
PREVENTING VIOLENCE
AGAINST CHILDREN 2020
EUROPEAN REGIONAL
STATUS REPORT ON
PREVENTING VIOLENCE
AGAINST CHILDREN 2020
public health problem with devastating consequences for the victims and their families. The total annual cost to the health systems of the Region of not preventing adverse childhood experiences, including violence, amounts to US$ 581 billion. This publication explores the progress that countries have made in implementing activities to achieve the Sustainable Development Goal (SDG) targets on ending violence against children by 2030 through the lens of the seven INSPIRE evidence-based strategies for ending violence against children. Data collected through a survey of government- appointed national data coordinators in 45 of the 53 Member States of the Region show that government support for the implementation of INSPIRE was highest for implementation and enforcement of laws (95%) and parent and caregiver support (78%), and lowest for income and economic strengthening (37%). Surveillance of violence against children remains inadequate, and most countries do not undertake regular surveys. To achieve the SDG targets, more support from governments is needed.
Keywords
VIOLENCE – prevention and control CHILD ABUSE – prevention and control CHILD WELFARE
CHILD RIGHTS EUROPE ISBN: 978-92-890-5549-9
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Contents
iv Foreword
vi Acknowledgements vii Abbreviations
ix Key facts 1 Introduction
7 European regional burden of violence against children
13 How countries are responding to violence against children
31 Way forward 35 References 38 Annex 1
Country profiles 84 Annex 2
National data coordinators 91 Annex 3
Homicide numbers and rates in participating countries 94 Annex 4
Corporal punishment of children across
the Region
Foreword
“Why did this happen to me?”
“Don’t my parents love me?”
“I’m so scared.”
“I feel so alone.”
These are the words of a child victim of violence. Sadly, words like these are all too common, with one in every three children in Europe experiencing some form of violence in their lifetime. The reasons behind these disturbing numbers are many and varied, but gender inequality, harmful use of alcohol and undermining of children’s rights are some of the most important and impactful contributors to this violence.
Violence is both an adverse health outcome in itself and a risk factor with so many other health and social consequences: its impact is just as devastating, even years later, as it was when first experienced. Guilt and anguish from violence linger and can lead to an increased risk of depression, suicidal ideation and adoption of harmful behaviours such as smoking, risky sexual activity, violence and substance misuse.
The rights of children and of childhood are clearly stated and universally agreed by all countries of the WHO European Region. Every childhood is worth fighting for, and every child is entitled to a happy start in life, without violence or adversity.
Traditionally, national efforts to combat violence have been response-based and led by the social and criminal justice systems; however, there has been rapid progress in implementing public health approaches to preventing violence against children before it occurs, replacing fear and pain with safe, stable and nurturing environments in which children can thrive.
In our efforts to end violence against children, we are currently at a tipping point. On the one hand, we have
the heartbreaking situation that one in three children in the Region experience some form of interpersonal
violence during their childhood. On the other side of the scale are our tools and strategies to measure,
advocate, prevent and respond to violence, the like of which we have never had before. Sustainable
Development Goal (SDG) target 16.2, the INSPIRE technical package and clinical guidelines for health-
sector responses together make breaking the cycle of violence all the more achievable.
Hans Kluge Regional Director WHO Regional Office for Europe completed by government-appointed national data coordinators in 45 of the 53 Member States of the Region.
While there is no doubt that positive strides have been made in the implementation of INSPIRE, there are clear differences in the level of government support for national violence prevention. Improved data and integration of INSPIRE strategies into existing national framework need to be more widely pursued.
We have an important opportunity and a responsibility to prevent violence and protect children by aligning our action with the United Nations Decade of Action for the Sustainable Development Goals and attaining SDG target 16.2 of eliminating violence against children by 2030. We hope that this report will provide policy-makers, practitioners and activists with the information they need to eliminate violence and act as a benchmark for the monitoring of progress in INSPIRE implementation.
Violence is preventable, not inevitable.
Acknowledgements
This report was written by: Dinesh Sethi (violence prevention consultant), Yongjie Yon and Jonathon Passmore (WHO Regional Office for Europe). It is based on a survey entitled Global status report on preventing violence against children. The WHO Regional Office for Europe is very grateful to the health ministries and other government- appointed national data coordinators for their dedicated hard work in collecting the country information for the survey questionnaire.
Yongjie Yon, as the Regional Data Coordinator, worked with the national data coordinators for the coordination and validation of data.
Jesus Castro Izquierdo and Nina Blinkenberg (WHO Regional Office for Europe) are thanked for their warm administrative support.
Heartfelt thanks are extended to the volunteers and interns from the Violence and Injury Prevention Programme of the WHO Regional Office for Europe who supported the validation of the data: Lucía Hernández-García (Hospital Universitario 12 de Octubre, Spain), Gianluca Di Giacomo (Catholic University of the Sacred Heart, Italy), Gabriella Sutton (University of Malta) and Julia Mutevelli (University of Bonn, Germany).
Particular thanks go to WHO staff members Alex Butchart and Stephanie Burrows for providing very helpful comments, and Bente Mikkelsen and Nino Berdzuli for their overall support for the report.
The WHO Regional Office for Europe thanks Fondation Botnar for its
generous financial support for the project and this report.
Abbreviations
ACE adverse childhood experience(s) GNI gross national income
GSRPVAC Global status report on preventing violence against children
HBSC Health Behaviour in School-aged Children study HIC high-income country
LMLC lower-middle-income and low-income country/countries
NDC national data coordinator
SDG United Nations Sustainable Development Goal UMIC upper-middle-income country
UNICEF United Nations Children’s Fund
UPR United Nations Human Rights Council Universal
Periodic Review
• The European regional status report on preventing violence against children 2020 explores the progress that countries have made in implementing activities to achieve the United Nations Sustainable Development Goal (SDG) targets on ending violence against children through the lens of the seven INSPIRE evidence-based strategies for ending violence against children.
• The report is based on a survey, the results of which were published in the Global status report on preventing violence against children. Of the 53 Member States in the WHO Regional Office for Europe, 45 States participated, representing 89% of the regional population of 771 million.
• The majority of countries (42) have multiple agencies responsible for violence prevention and the remaining countries (3) have one single agency. In addition, 14 countries have one sector responsible for coordinating within the government on violence prevention, nine have two sectors and the remaining 20 countries have three or more sectors.
• Many countries have some mechanisms to support national violence prevention work, 34 countries have national plans for preventing violence; on average, about 56% of these action plans are fully funded.
• While 38 countries have population surveys of violence against children, most of the countries do not undertake surveys at regular intervals.
• It is estimated that, in 2017, over 1000 children aged 0–17 years in the WHO European Region were killed due to homicides and assault.
• There are differences in the level of government support for the implementation of the INSPIRE strategy. Support was highest for the implementation and enforcement of laws (95%), followed by parent and caregiver support (78%), response and support services (76%), education and life skills (72%), norms and values (64%) and safe environments (63%), and lowest for income and economic strengthening (37%).
• While INSPIRE implementation was generally higher in high-income countries, parent and caregiver support was reported as higher in lower-middle- and low- income countries.
• A majority of countries have laws against violence against children; laws restricting exposure to alcohol and firearms are widely enacted but often inadequately enforced.
• INSPIRE strategies should be better integrated into existing national frameworks and the implementation of INSPIRE strategies needs more widespread support by governments in order to end all forms of violence against children by 2030.
Key facts
egional Office for Europe.
Introduction
Notwithstanding these expectations, violence against children is very common and results not only in grave, immediate and long-term health consequences, but also in educational and social disruption (2–4). The concept covers all forms of violence against children aged under 18 years, including physical, sexual and emotional violence (as well as witnessing violence); it may be perpetrated by parents, other caregivers, peers or strangers. This regional report is published in parallel with the first ever Global status report on preventing violence against children (5). It addresses three main types of interpersonal violence affecting children:
• child maltreatment – the abuse and neglect of children by parents and caregivers, most often in the home, but also in settings such as schools and orphanages;
• youth violence – this mainly concerns children aged over 10 years who may or may not be acquainted with one another; it includes bullying (including cyber-bullying), physical fighting and sexual or physical assault, and most often occurs in the community and schools; and
• intimate partner violence – this involves violence and abuse within an intimate relationship which causes physical, emotional, sexual or psychological harm.
1Background Around the world, children have a strong insight into what enables their well-being and happiness. Among these, factors considered most important are caring families, freedom from violence, cohesive neighbourhoods and the right to education (1).
The aim of the Global
status report on preventing violence against children was to assess the way that governments are responding to their commitments under SDG target 16.2 (6) on eliminating all violence against children.
Objectives Member State actions reviewed and quantified in this status report include:
• putting in place effective national action plans, policies and laws;
• measuring fatal and non-fatal violence;
• establishing quantified baseline and target values to monitor progress; and
• implementing evidence-based interventions included in INSPIRE: seven strategies for ending violence against children (7).
This regional report details national responses and country- specific recommendations for the Member States of the WHO European Region.
1 Children may also be affected by other types of violence that go beyond the scope of this report, including self-directed violence, suicidal behaviour and self-harm, and collective violence such as war and terrorism committed by larger groups of people. In addition, this report does not explicitly address human trafficking or female genital mutilation/cutting, both of which are extensively covered elsewhere.
Violence affects children of all ages and in all societies. It is a leading cause of health and development inequality and social injustice.
Children may experience multiple and different types of violence simultaneously and/or at different stages in their life course. The different forms of violence that children suffer are interrelated, sharing not only risk factors and ill-effects, but also protective factors and evidence-based strategies for prevention and response.
As well as the multiple types of violence that children may experience throughout their childhood, they may also be exposed to other types of adversity, including family and household dysfunction, such as living with a household member with drug or alcohol abuse, mental illness, incarceration or witnessing domestic violence (8). Childhood is a period of extensive neurological, physical and emotional development. Violence and other adversity can result in toxic stress, brain maldevelopment and cognitive dysfunction, leading to the adoption of health-harming behaviours such as substance misuse. Over the life course, these determinants can result in the development of mental illness or noncommunicable diseases or may lead to premature death, suicide and the intergenerational transmission of violence (4, 8–12). Violence exacerbates inequality because of its health and social impacts, thereby perpetuating cycles of deprivation. It interferes with children’s educational and social achievement, impeding societal development. The economic burden resulting from violence against children not only directly impacts services such as health and welfare and the costs of criminal justice, but also incurs indirect costs to society. Studies demonstrate that the cost of violence against children is high, amounting to the loss of 1–2% of a country’s gross domestic product (13).
The economic devastation caused by the COVID-19 pandemic will further exacerbate inequalities owing to the associated loss of income, and school closures and movement restrictions will likely produce greater stress and anxiety in overcrowded households, without the potential for support from the community, thereby greatly increasing the likelihood of violence against children. This emphasizes the fact that now, more than ever, is the time for governments and civil society
Why is prevention of violence against children so
important?
The United Nations Convention on the Rights of the Child defines a child’s right to health and well-being and a childhood free from violence and other forms of adversity (14). The prevention of violence against children features prominently in the 2030 Agenda on Sustainable Development, with four targets (5.2, 5.3, 16.1 and 16.2) addressing the ending of violence and several more (within Goals 1, 3, 4, 5, 10, 11 and 16) focusing indirectly on risk factors for violence. Specifically, SDG target 16.2 calls for “ending all forms of violence against children by 2030” (6, 15). The SDGs are inherently intersectoral, representing a whole-of-government and whole-of-society commitment to action.
The seven INSPIRE strategies for ending violence against children involve the education, health, justice and social welfare sectors among others, and are intended to reinforce each other (Table 1) (7).
Reducing violence against children is a priority in the WHO Thirteenth General Programme of Work, 2019–2023 (16), with the adoption of Target 14 to reduce by 20% the number of children who experienced violence in the past 12 months, including physical and psychological violence by caregivers.
An action plan entitled Investing in children: the European child maltreatment prevention action plan 2015–2020 (WHO Regional Office for Europe document EUR/RC64/13) was adopted by Member States of the WHO European Region in 2014 (17). The action plan called on countries to reduce child maltreatment, a common type of violence against children, by 20% by 2020, focusing on reducing risks through evidence-based intersectoral preventive action. Good progress has been made, though a recent evaluation suggests that greater government and civil society commitment to concerted action is essential for reducing child maltreatment.
WHO, with several other international agencies and entities, including the Global Partnership to End Violence Against Children, has developed a technical package called INSPIRE: seven strategies for ending violence against children to support Member States in preventing and responding to violence against children. The recommended strategies and approaches are outlined in Table 1 along with cross-cutting activities such as policy action, monitoring and evaluation. Supporting handbooks and monitoring frameworks are available (18, 19). These require intersectoral action, and the United Nations Decade of Action for the SDGs provides an overarching policy framework for collaborative working.
Calls to action
Strategy Approaches Cross-cutting activities Implementation and
enforcement of laws • Laws banning violent punishment of children by parents, teachers or other caregivers
• Laws criminalizing sexual abuse and exploitation of children
• Laws that prevent alcohol misuse
• Laws limiting youth access to firearms and other weapons
Multisectoral action and coordination Monitoring and
evaluation Norms and values • Changing adherence to restrictive and harmful
gender and social norms
• Community mobilization programmes
• Bystander interventions
Safe environments • Reducing violence by addressing “hotspots”
• Interrupting the spread of violence
• Improving the built environment Parent and caregiver
support • Delivered through home visits
• Delivered in groups in community settings
• Delivered through comprehensive programmes Income and economic
strengthening • Cash transfers
• Group savings and loans combined with gender equity training
• Microfinance combined with gender norm training Response and
support services • Counselling and therapeutic approaches
• Screening combined with interventions
• Treatment programmes for juvenile offenders in the criminal justice system
• Foster care interventions involving social welfare services
Education and life
skills • Increase enrolment in pre-school, primary and secondary schools
• Establish a safe and enabling school environment
• Improve children’s knowledge about sexual abuse and how to protect themselves against it
• Life and social skills training
• Adolescent intimate partner violence prevention programmes
Table 1. INSPIRE strategies, approaches and cross-cutting activities
Data were collected through a standardized questionnaire from 45 of the 53 countries of the WHO European Region, covering 89%
of the regional population of 771 million. The remaining eight countries either declined to participate or did not submit completed documentation by the close of the survey. The methods are described in full in the Global status report on preventing violence against children (5) and summarized in Fig. 1.
The country profiles presented in Annex 1 provide core information about preventing and responding to violence against children, as reported by participating countries. The national data coordinators (NDCs) who coordinated the survey are listed in Annex 2.
Of the 45 countries that participated, 26 were classified as high- income countries (HIC), 14 as upper-middle-income countries (UMIC), and five as lower-middle-income and low-income countries (LMLC). Geopolitically, 25 were from the European Union and 11 from the Commonwealth of Independent States (20).
Methods
Fig. 1. Methodology of the Global status report on preventing violence against children
Global and regional level coordination
National consensus meeting One national data set
Validation
Government clearance
Data entered into online database, exported for analysis National data coordinator (NDC)
in each country/area Supporting documentation
NDC collects and submits national action plans, legislative texts, and
other supporting documents
Questionnaire data
Multisectoral group of 6–10 representatives from ministries of health, justice, education, gender and women, children, and interior, and
nongovernmental organizations
European
regional burden of violence
against children
Given the social sensitivity of violence and the fact that incidents are often hidden by perpetrators and/or family members, gathering comprehensive data on the burden of violence requires the use of multiple information sources, including vital registration, hospital admissions, child protection agency contacts and representative and population-based surveys.
Violence is
the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation (2),
irrespective of the operational definition used by each information source.
Effective societal measures to prevent violence against children depend on the availability of complete and reliable data.
Mortality data Official homicide statistics are often the most readily available data in the Region on deaths resulting from violence against children.
Based on the most recent available data, homicides of children aged 0–14 years decreased by 13.6% between 2010 and 2015; in the latter year, homicide rates in the Region were 0.31 per 100 000 children (0–14 years). Inequalities persist across the Region, with rates being almost twice as high in the Commonwealth of Independent States (0.43 per 100 000 children 0–14 years) as in European Union countries (0.26 per 100 000 children 0–14 years), although the figures are converging (21).
Other data on violence
Data from child protection agencies relating to children who
experience violence and who access support services can be a useful
source of information on children who are known to have suffered
from or be at risk of violence, although the definitions and practices
for referral and service provision may vary between countries and
can be influenced by workforce resource and capacity.
Population-based surveys offer crucial information to establish the true magnitude of the problem of violence against children. Such representative surveys are the only way to assess the prevalence of violence that is not captured from administrative data (22). A recent meta-analysis showed that, globally, at least one billion children experienced violence in the past 12 months. In the European Region, 12% of children aged 2–17 years (15.2 million children) experienced violence in the past 12 months (23).
The European report on preventing child maltreatment documented a series of meta-analyses
1on the prevalence of child maltreatment.
The prevalence ranged from 9.6% for sexual abuse (5.7% for boys and 13.4% for girls), 22.9% for physical abuse, 16.3% for physical neglect and 18.4% for emotional neglect to 29.6% for emotional abuse. From these data, it is estimated that at least 55 million children have experienced some form of violence during their childhood.
One-off surveys of adverse childhood experiences have been undertaken in at least 17 countries of the Region. In 13 countries, these surveys were supported by the WHO Office for Europe;
multisectoral policy dialogues were held to disseminate the results and recommend the next steps for preventive action. Four countries have incorporated elements of their surveys on adverse childhood experiences into the surveys that they conducted in 2017/2018 as part of the Regional Office’s Health Behaviour in School-aged Children (HBSC) study.
The HBSC surveys are carried out periodically in children aged 11, 13 and 15 years and report a high prevalence of past year bullying ranging from 4% (Sweden) to 35% (Lithuania). Past-year prevalence of fighting is also high, ranging from 9% (North Macedonia) to 36% (Belgium) (24). Children who experience bullying are much less likely to fulfil their educational potential at school as evidenced by lower grades and absenteeism, as well as suffering physical and mental harm (25).
Population-based
surveys
The consequences of violence against children
Surveys on adverse childhood experiences (ACE) have been undertaken in at least 17 countries of the Region. A meta-analysis of ACE surveys undertaken among university and college students shows that at least half the respondents had experienced at least one ACE during childhood and that the prevalence was high:
sexual abuse 7.5%, physical abuse 18.6%, emotional abuse 8%, emotional neglect 11.8% and witnessing violence against the mother (14.6%) (26). Violence in childhood, whether it is due to maltreatment or other forms of interpersonal violence along with household dysfunction, has far-reaching consequences. Research has shown that, compared with people experiencing no ACEs, those who have four or more ACEs are twice as likely to smoke, 4.3 times as likely to experience problematic alcohol use, 3.7 times as likely to abuse drugs, 6.2 times as likely to need therapy and 17.7 times as likely to attempt suicide (27). Supportive childhood relationships independently moderated the risks of smoking, problematic alcohol use, therapy and suicide attempts. In those with four or more ACEs, adjusted proportions reporting suicide attempts decreased from 23% for people with low supportive childhood relationships to 13%
for those with higher support. Equivalent reductions were 25% to 20% for therapy, 23% to 17% for problematic drinking and 34%
to 32% for smoking (27). This further emphasizes the importance of supportive and violence-free environments in childhood, as proposed in the INSPIRE package (7).
A larger combined analysis, involving over 250 000 participants, also found that individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs (28). There was an increased risk, by a factor of 2–3, for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease and respiratory disease, an increased risk, by a factor of 3–6, for sexual risk-taking, mental ill health and problematic alcohol use, and an increased risk, by a factor of more than 7, for problematic drug use and interpersonal and self-directed violence. One matter of interest is that some ACE outcomes, such as violence, mental illness and substance abuse, also represent ACE risks for the next generation, emphasizing the importance of investing in prevention, response services and resilience-building.
Similar findings have also been demonstrated in a population-based
cohort study, indicating an increase in all-cause mortality risk, with
accidents, suicides and cancer as common causes of death among
those who were exposed to high childhood adversities (29).
The costs of violence against children
Violence places a huge economic burden on health care (30). Other than the immediate harm that violence and other ACEs cause in children, the long-term health consequences are also considerable manifesting in mental illness and noncommunicable disease. In the European Region a total of 16.4 million disability-adjusted life-years for harmful alcohol use, illicit drug use, smoking, obesity, anxiety, depression and noncommunicable disease are attributable to ACEs.
This is equivalent to a loss of US$ 581 billion or 2.67% of the gross
domestic product attributable to ACEs (27). There are additional
costs to the justice, education and welfare systems, as well as the
opportunity costs of unfulfilled potential.
Artwork by Sasha, aged 5, © WHO Regional Office for Europe.
How countries are responding to violence
against children
Of the 45 countries responding to the survey reported in the Global status report on preventing violence against children (GSRPVAC), 42 countries have multiple agencies or departments responsible for violence prevention, while the remaining three countries have a single agency or department. However, to achieve a collective impact with coordinated action, a designated lead agency with sufficient authority and resources is needed. The lead agency is responsible for coordinating the action, including the implementation of action plans and orchestration of inputs from multiple sectors. In the European Region, 14 countries have one sector responsible for coordinating between government ministries, and nine countries have two sectors.
The remaining 20 countries have three or more sectors, with some reporting that up to eight sectors are responsible for coordination, suggesting that national responses may be fragmented along sectoral lines. Alarmingly, despite having multiple sectors responsible for violence prevention activities, two countries did not report having any sector responsible for coordinating between government ministries.
Multisectoral engagement and whole-of-society approaches are essential building blocks for effective plans and policies. Civil society engagement was high, with 37 countries involving nongovernmental organizations, 20 involving academia and five involving the private sector. In addition, United Nations agencies were involved in 10 countries, and other international agencies were engaged as stakeholders in a further 10 countries.
A total of 34 countries (76%) had national government plans that set out the main principles, goals and objectives for preventing violence.
However, only six countries (13%) had plans that also contained at least one prevalence indicator. Twenty-four countries (53%) had plans for all five types of violence against children. As regards child maltreatment, 30 countries (67%) had national plans, one had a subnational plan and 14 countries had no plans. Plans against sexual violence were present in 30 countries, one had a subnational plan and 14 had no national plan. For gender-based violence, there were national plans in 29 countries (64%) and one further country had a subnational plan. National plans for school-based violence were present in 27 countries (60%) and one had a subnational plan. For youth violence, only 24 countries (53%) had a national plan and three had subnational plans. Table 2 shows a listing of countries with an action plan or policy to prevent violence against children.
Multisectoral collaboration and leadership
Violence prevention
requires coordinated
sectoral action from
multiple sectors.
Table 2. National action plans or policy addressing violence against children
National action plans addressing violence against children
Child maltreatment Youth violence Sexual violence
Country Existence Funding Existence Funding Existence Funding
Albania National Partial National Full National Partial
Armenia National Partial Subnational – National Partial
Austria National Full National Full National Full
Azerbaijan No – No – No –
Belarus National Full National Full National Full
Belgium National Partial National Partial National Partial
Bosnia and Herzegovina National Partial National Partial National Partial
Bulgaria National Full National Full National Full
Croatia National Full National Full National Full
Cyprus No – No – National Full
Czechia No – No – No –
Denmark National Full National Full National –
Estonia National Partial National Partial National Partial
Finland National – National Partial National Partial
France National Full National Full National Full
Georgia No – No – No –
Germany Subnational – Subnational – National Full
Greece No – No – No –
Israel National Full National Full National Full
Kazakhstan No – No – No –
Kyrgyzstan National Full National Full National Full
Latvia National Partial National Full National Partial
Lithuania National Full National Full National Full
Luxembourg No – No – No –
Malta National Full No – National Full
Montenegro National Partial National Partial National Partial
North Macedonia National Partial National Partial National Partial
Norway National Partial Subnational Full National Partial
Poland No – No – No –
Portugal National Full National Full National Full
Republic of Moldova National Partial National Partial National Partial
Romania National Full National Full National Full
Russian Federation No – No – No –
San Marino National Full No – No –
Serbia National Full National Full National Full
Slovakia National Partial National Partial National Partial
Slovenia No – No – No –
Spain National Full National Full National Full
Sweden No – No – National Full
Switzerland National Full No – No –
No – No – No –
Table 2 contd
National action plans addressing violence against children
School-based violence Gender-based violence Other Contains at least one prevalence
indicator Country Existence Funding Existence Funding Existence Funding
Albania National Full National Partial No – No
Armenia National Partial National Partial National Partial Yes
Austria National Full National Full National Full Yes
Azerbaijan No – No – No – No
Belarus National Full National Full No – No
Belgium National Partial National Partial No – No
Bosnia and Herzegovina National Partial National Partial National Partial No
Bulgaria National Full National Full No – No
Croatia National Full National Full National Full No
Cyprus National Full No – National Full No
Czechia No – No – No – No
Denmark National Full National Full No – No
Estonia National Partial National Partial No – Yes
Finland National Partial National Partial No – Yes
France National Full National Full No – No
Georgia No – No – No – No
Germany Subnational – Subnational – No – No
Greece No – No – No – No
Israel National Full National Full No – No
Kazakhstan No – No – No – No
Kyrgyzstan National Full National Full National Full No
Latvia National Partial National Partial No – No
Lithuania National Full National Full No – No
Luxembourg No – No – No – No
Malta No – National Full No – –
Montenegro National Partial National Partial No – Yes
North Macedonia National Partial National Partial No – No
Norway National Partial National Partial No – No
Poland No – No – National Full No
Portugal National Full National Partial No – No
Republic of Moldova National Partial National Partial No – No
Romania National Full National Full No – No
Russian Federation No – No – No – No
San Marino No – No – No – No
Serbia National Full National Full Yes Full No
Slovakia National Partial National Partial No – Yes
Slovenia No – No – No – No
Spain National Full National Full No – No
Sweden No – National Full National Full No
Switzerland No – No – No – No
Tajikistan No – No – No – No
Turkey No – No – No – No
Ukraine National Partial National Partial No – No
United Kingdom No – National – No – No
Uzbekistan No – No – No – No
Even where national action plans exist, they are not fully funded in all countries (Fig. 2). Overall, national action plans are only fully funded for child maltreatment in 17 countries, for youth violence and sexual violence in 16 countries, for school-based violence in 15 countries and for gender-based violence in 14 countries. On average, about 56% of these action plans are fully funded. It is alarming that so many countries do not adequately fund these policies, which are crucial for achieving SDG target 16.2; this limits their efficacy. Plans were more likely to be fully funded in HIC compared with UMIC or LMLC. A previous analysis of national action plans for preventing violence against children showed that key policy areas requiring improvement were quantifiable objectives and allocated defined budgets (31, 32). The present analysis reiterates the need for urgent policy action in this area. One example of a comprehensive national action plan comes from Finland (Box 1) which fulfils the important criteria of multisectoral engagement, presence of a lead agency, adequate funding, quantifiable targets and evidence-based programming (32).
“Let’s make every kid a safe kid – together” (Ulla Korpilahti, Finnish Institute for Health and Welfare) In 2014, reflecting public concern about violence against children, the Member States of the WHO European Region endorsed the plan Investing in children: the European Child Maltreatment Prevention Action Plan 2015–2020. This was followed in 2016 by the Handbook on developing national action plans to prevent child maltreatment published by the Regional Office for Europe, with the key message to policy-makers and civil society that “child maltreatment is not inevitable: it can be prevented by taking a multisectoral, multifactorial public health approach to prevention”.
The political will to make progress on this issue is strong, but the picture is mixed: among the Member States of the Region, 83% have an action plan on violence against children, but fewer than half of them have the funds to implement it.
Finland’s new action plan, Non-violent Childhoods – Action Plan for the Prevention of Violence against Children 2020–2025, is designed to be used as a handbook by policy-makers and professionals such as doctors, teachers, health and youth and social workers. Finland has a long and well monitored tradition of supporting parenthood and helping children and youth and families in maternity and child health clinics and school health-care services. Despite the alignment of legislation with national and international treaties, children in Finland – as in other countries – have been subjected to violence of various types, both physically and mentally. Emotional violence at home, such as threats of hitting, yelling, name-calling, throwing things and kicking, was reported in 2019 by 17 % of 4th and 5th grade elementary school pupils (aged 10–11 years), by 28% of 8th-9th grade secondary school pupils (aged 14–15) and at general upper secondary school (aged 16–19) According the same study one tenth (10%) of pupils in grades 4 and 5 of basic education had seen or otherwise witnessed physical violence between other family members over the last 12 months, while the figure for eighth and ninth graders stood at 11%. About one third of parents in Finland said in a large Finnish-Swedish study that they had used some form of disciplinary violence against their children aged 0–12 years during the previous 12 months.
Action plans on violence against children – Finland
Box 1.
Non-violent Childhoods runs from 2020 to 2025. It contains 93 measures for preventing violence against 0–17-year-old children and young people. “In the past we have found that having an action plan really focuses the mind, especially among those who know what is going on and are determined to improve children’s lives”, says Korpilahti.
The Finnish action plan covers the prevention of physical and emotional violence, sexual violence and online harassment. The measures it lists are based on research results and needs that have arisen in the specialists’ work. It emphasizes the importance of the United Nations Convention of the Rights of the Child, the WHO INSPIRE package, the SDG targets, particularly targets 5.2, 16.1 and 16.2, multidisciplinary cooperation and child inclusion.
The manual contains, among other things, checklists, practical examples and tried and tested measures to prevent and reduce violence. It lays special emphasis on better coordinated and timely support for children subjected to violence, focusing on factors that protect children from violence, recognizing and addressing parents’ own backgrounds and adverse childhood experiences, and the importance of predicting and detecting threats early, such as when parents are divorcing or when they are badly stressed. The aim is also to enhance professionals’ ability to identify and intervene in issues such as honour and violent extremism; and, importantly, to ensure that children themselves know where to go for help.
The prevention of violence requires multidisciplinary cooperation between various specialists;
the process by which this action plan was developed is remarkable. Over 80 specialists from different organizations and over 40 referees were involved in the preparation of the action plan, and statements were requested from many different parties. A steering group, five ministries and 28 other organizations are tasked with implementing the plan, which will be evaluated in 2022.
As Korpilahti said, “My 25 years’ experience in this field have shown me that just writing a policy paper doesn’t work, it has to be built from the ground up, with commitment, good coordination and enthusiasm. But commitment from the ministries is also central to success.”
The Non-violent Childhoods Action Plan 2020–2025 makes it clear that investing in freedom from violence for children now will have a beneficial effect for the rest of their lives. “Violence disturbs and damages a child’s development and induces fear and mistrust towards people and the society. According to research results, adverse childhood experiences, such as violence, have an association with morbidity and repetition of violence in adulthood. At its worst, violence may even lead to death. Besides human suffering, violence causes costs as the number of mental health disorders, high-risk behaviour and social exclusion increases”, said Korpilahti.
Other key points in the action plan are:
• a comprehensive cooperation model, based on the Barnahus quality standards, is created to support all children subjected to abuse or sexual violence;
• violence, harassment or bullying should be addressed in all client meetings of the pupil welfare services;
• particular targeting of those who are especially vulnerable, including children with disabilities or other impairments, those from ethnic or language minorities and those in care outside the home, as well as sexual and gender minorities; and
• clear information for children and youth indicating where they can tell someone about sexual harassment, grooming or other violence, and where to get help.
Box 1 contd
A summary is available and a version will also be published in English. The Finnish Institute for Health and Welfare has appointed a steering group that is drawn from five ministries and 28 other organizations in cooperation with several working groups to follow up the implementation of the plan. The first evaluation will be undertaken in 2022. It is anticipated that, because
different agencies will be working together, implementation will not be costly.
For further information, see:
• Investing in children: the European child maltreatment prevention action plan 2015–2020. Copenhagen: WHO Regional Office for Europe; 2014 (EUR/RC64/13; http://www.euro.who.int/__data/assets/pdf_file/0009/253728/64wd13e_InvestChildMaltreat_140439.
pdf?ua=1, accessed 3 March 2021);
• Gray J, Jordanova Pesevska D, Sethi D, Ramiro González MD, Yon Y. Handbook on developing national action plans to prevent child maltreatment. Copenhagen: WHO Regional Office for Europe (http://www.euro.who.int/en/health-topics/disease-prevention/
violence-and injuries/publications/2016/handbook-on-developing-national-action-plans-to-prevent-child-maltreatment-2016, accessed 3 March 2021);
• New action plan provides means to prevent violence against children. In: Finnish Institute for Health and Welfare [website].
Helsinki: Finnish Institute for Health and Welfare; 2019 (https://thl.fi/en/web/thlfi-en/-/new-action-plan-provides-means-to- prevent-violence-against-children, accessed 3 March 2021).
• Kouluterveyskyselyn tulokset [Results of the school health survey]. In: Finnish Institute for Health and Welfare [website]. Helsinki:
Finnish Institute for Health and Welfare; 2021 (http://www.thl.fi/kouluterveyskysely/tulokset, accessed 3 March 2021);
• Korpilahti U, Kettunen H, Nuotio E, Jokela S, Nummi VM, Lillsunde P. Non-violent childhoods – action plan for the prevention of violence against children 2020–2025. Helsinki: Ministry of Social Affairs and Health; 2020 (http://urn.fi/, accessed 3 March 2021).
Box 1 contd
Fig. 2. Number of countries with fully funded national action plans by type of violence and country income Number of countries with fully funded national action plans
Number of countries (N=45) by type of violence and country income
Gender-based violence
School-based violence
Sexual violence
Youth violence
Child maltreatment
0 5 9 14 18
Type of violence
WHO European Region (N = 45) HIC (N = 26) UMIC (N = 14) LMLC (N = 5)
Unlike other parts of the world, the majority of countries in Europe have reasonable homicide data from police and vital registration sources. Table 3 shows that even among high- and upper-middle- income countries, the percentage of countries with data ranged from 43% to 71%. Only 20% of the countries in lower-middle- and low- income countries have provided police and vital registration data for children aged 0-17 years. It must be pointed out that homicides are only indicative of a small fraction of the true burden of violence against children. For example, it is estimated that for every child death, there are between 150 and 2400 cases of significant physical abuse (33). Based on the WHO estimated number of homicides counts for the latest year available, there were 1099 homicides in children aged 0-17 years (5).
Data collection
Country income level Data source
Police % Vital registration % All ages 0–17 years All ages 0–17 years
High (N=26) 73.1 61.5 65.4 61.5
Upper-middle (N=14) 71.4 71.4 50.0 42.9
Lower-middle/Low (N=5) 60.0 20.0 20.0 20.0
WHO European Region (N=45) 71.1 60.0 55.6 51.1
Table 3. Percentage of countries able to supply homicide data for 2017 (or closest single year) by data source, age, and country income level
Table A3.1 in Annex 3 provides reported or estimated homicide numbers for all participating countries. Rates between countries in the European Region ranged from zero deaths per 100 000 to 1.2 deaths per 100 000 children (0–17 years). It can be observed that the rates in central and eastern European countries were substantially higher than in western European countries.
Population surveys of violence against children have been undertaken in 38 countries, and a further two are planning to undertake a survey.
Most countries do not undertake surveys at periodic intervals in order to monitor whether measures to combat violence are resulting in a reduced prevalence of violence, although this is essential for monitoring progress. Of interest is the fact that, among the 34 countries that have national action plans, only six countries (18%) have plans that contains at least one prevalence indicator. To maximize the value of data gathered on the prevalence and incidence of violence against children, such information must feed into the development and monitoring of strategic plans for the implementation of evidence-based interventions.
(N = 45 reporting countries)
Fig. 3. Percentage of countries reporting any support for INSPIRE strategies
EURO HIC UMIC LMLC
Legislation
Norms and values
Safe environments
Parent and caregiver support
Income and economic strengthening Response and support
Education and life skills
100.00 75.00 50.00 25.00
Implementation of INSPIRE strategies
Reasonable progress is being made across the Region (Fig. 3). There was government support for implementing INSPIRE strategies;
this was highest for the implementation and enforcement of laws (95%), followed by parent and caregiver support (78%), response and support services (76%), education and life skills (72%), norms and values (64%) and safe environments (63%), and lowest for income and economic strengthening (37%). When compared by country income, implementation was generally higher in HIC. Three areas where concerted improvement is needed, particularly in LMLC, are norms and values (27%), income and economic strengthening (33%), response and support services and education and life skills (each 57%). Conversely, parent and caregiver support was reported as higher in LMLC.
Are countries implementing the seven INSPIRE strategies?
WHO European Region
HIC
UMIC
LMLC
In addition to assessing the implementation of INSPIRE strategies, further analysis was conducted to assess how far the approaches within each strategy are reaching all their intended beneficiaries.
Respondents were asked to provide their best estimate of the extent to which national approaches were reaching all, or nearly all, children who needed them. This was done using a rating scale ranging from 1, where an approach was considered to reach very few who needed it, to 10 for an approach considered to be reaching almost all who needed it. The median of the respondents’ scores was calculated and assessed according to three levels of reach: low reach (reaching very few in need) for ratings up to 3.3; medium reach (reaching some in need) for ratings from 3.4 to 6.7, and high reach (reaching all or nearly all) for ratings from 6.8 to 10. These results are presented under each of the strategies.
Implementation and enforcement of laws
All 45 participating countries have laws that ban sexual violence. Based on the latest legislative review from End Corporal Punishment, Table A4.1 in Annex 4 shows that corporal punishment is banned in all settings
1in 35 countries; 13 countries have a ban but not in all settings; and five countries have a government commitment to full prohibition (34). However, surveys from some countries report that, despite the enactment of legislation, a large proportion of children and parents nevertheless continue to use physical violence.
In keeping with their commitment to the United Nations Convention on the Rights of the Child, countries should enact and enforce such laws, and step up efforts to change the attitudes of parents and caregivers about the benefits of non-violent, positive parenting.
Other laws banning violence and the extent of their enforcement are shown in Fig. 4. Although laws exist in many countries, these are not well enforced. Only 20 of 40 countries with laws that ban corporal punishment enforce these effectively, and for statutory rape this is enforced well in only 36 of the 45 countries. Clearly, laws will only be effective if they are well enforced. See Box 2 for a good-practice example from Georgia.
1 Corporal punishment in all settings includes home, schools, day care, alternative care and penal institutions.
